birdog1960

let's define relevant. 1 person is not politically relevant unless that person is trayvon martin or george zimmerman. 1 person without health insurance that cannot afford necessary care is morally relevant. but it's not politically feasible to craft legislation around that 1 person. so, yes 1 person is morally relevant but 100000 are politically relevant.

um, the aca is the law. it's not likely going anywhere soon.

no idea...doesn't matter - here were talking about 100000 employed people and we both agree that's relevant.

nope, not at all. if we can't get single payer, we need to at least require large companies to do the right thing by their employees. yes, priciples matter. and it does have some economic affect in terms of fines expected - several billion dollars. that and aat least 100000 people seem like relevant, meaningful numbers to me. perhaps not to you but i can't fathom why not. doesn't matter if by choice or not. the massive number of ininsured results in cost shifting and unaddressed chronic illnesses that get attention when it's too late and/or most expensive. and at what percentage of income is health insurance cost a choice? is a $10000 policy for someone making $40k a real choice?

except that the 0.1% of the population employed by large co's and not insured will surely not agree with you about its necessity. but when you're talking 50+mil uninsured, what's 100k people or so?

http://www.nationaljournal.com/domesticpolicy/obamacare-study-employer-mandate-may-not-matter-much-but-the-individual-mandate-does-20130716. minimal difference in the number of uninsured and costs if employer mandate delayed. this is really no surprise as most large employers already routinely provide health insurance, a fact all together lost or ignored by opponents of the aca.. so obama's delay on the employer mandate changes little on a practical level. the starting level of uninsured is the most staggering thing here. almost 20% of americans uninsured.

This site disagrees with the basic facts you presented: http://www.calhealth.net/California_HSA_Plans_and_Health_Reform.htm. but ya'll never let facts get int he way of bashing the aca. Even if your version of the truth holds "the only reason to purchase in the exchange is if you are eligible for a health subsidy...it's hard to imagine how people making up to the poverty level might also want to fund a separate hsa". no doubt, there will be problems with the roll out of this huge plan. this is just not one of them. how so? the value of per diem and expert witness work is likely to decrease proportionally to average reimbursement for conventional practice.

hear this all the time but rarely see it come to fruition...what are you gonna do instead? even at medicare rates what will you do that will make you anywhere near the income? if you've got enough to retire early then you're in the minority based on data i've recently seen. if that's the case, then more power to you. if not, then go for it. everyone is replaceable and there's almost no where in the world you'll make as much on average as you make here.

well, because then he gets medicare rates for everyone he treats and that would be bad for him.been learning about aco's (accountable care organizations) recently... the next panacea to save for-profit healthcare from collapse. in short, they're a lot like hmo's that we all knew as such successes. once again, cost savings are to come from primary care doctors delivering more care and discouraging utilization. doesn't matter that there's not enough primary care docs now or in the pipeline to do the job and that this will discourage even more as it adds no tangible incentives. doesn't matter that in the current fee for service environment, discouraging utilization is nearly impossible. doesn't matter that we pump out more and more proceduralists from training programs that increase utilization more every year. another brilliant idea originating in the bush admin (mcclellan). 7 pages on it in the aca and everybody with an interest in maintaining the status quo jumps on it. reducing costs takes fundamental change that almost all the stakeholders are fighting tooth and nail. these piecemeal interventions have failed again and again. utilization differences account for about 17% of the large cost difference for caring for pt in the us vs canada. most of the rest come from administrative costs, inflated fees and profit. so this model attacks utilization and not administrative costs and profits....makes perfect sense right? and oc questions why a nurse wastes her talent teaching people how to write notes for maximal reimbursement...

just the kind of response an academic scientist looks for in a protege.

perhaps they didn't see the potential. inquiring and receptive mind and all....

just a taste: .

very good stuff. that first song is the one they did on letterman, i think. i'm sure they are happy for the exposure but these dudes can do so much more. the fiddle player is so fast it's unbelievable and their harmonies are awesome. wish they'd have used those a bit more in this album. but even without that, it's really good and i'd go see that show in a heartbeat.

yup, i'm pretty certain of that. they're playing some pretty cool places (telluride, charleston sc, a bluegrass cruise, etc) lately though, so i guess it's not so awful bad. i taped there scheduled performance on letterman with edie brickell and steve martin and they were like invisible studio musician playing simple backup stuff...i felt bad for them knowing what kind of stuff they can do but they probably made a nice paycheck.

to clarify, i think the aca will eventually lead to single payer and that ehr's will be even more important in that framework. whether progression from aca to single payer is by design is purely speculation.

i've said all along that the aca is a work in progress. ehr's are as well but also part of the overall plan. just my opinion.

i don't think anyone ever imagined that. they imagined more cost effectiveness and quality data along with more oversight and control over costs and waste. but mostly they're just part of the trojan horse.

it's pretty tough to predict who is gonna make it big and who is gonna still be playing the dive bars, in my experience. unfortunately, talent clearly isn't always the deciding factor but these guys have it. amazingly, the band that just won the bluegrass grammy for best album, Steep Canyon Rangers, gets $10k minimum in comparison... mommas don't let your babies grow up to be bluegrass artists.

was recently talking to a guy that books bands for his restaurant and local events. $50k minimum for the avetts. that really surprised me. top americana brings big bucks.

http://www.buffalonews.com/apps/pbcs.dll/article?AID=/20130710/BUSINESS/130719892/1003 "it's a win-win". well, yeah, it would be if that touted socially responsible employer, wegman's ,didn't employ part-time to full-time workers at a ration of nearly 4:1 even before the ACA affects them.

all very interesting stuff. supports my theory that most people are fundamentally good. we'll make a progressive of you, yet. a right leaning progressive probably, but a progressive nonetheless. the hemingway imitations in notes aren't primarily about style. they're about the difference between a note that immediately paints a vibrant picture of a patient and her problems in a few sentences and one that conveys almost nothing in 3 pages of computer template generated, cookie cutter vomitus. every colleague i discuss this with does the same thing on such notes: reads the first sentence to obtain demographic info then skips to the end to see the impression and plan. even this is usually woefully inadequate because this is usually free form and most docs hate typing. the bright side is that ehr's are moving the system closer to single payer. small practices can't afford them and are thus joining mega groups and systems. this advances ACO's and integrated delivery systems. it's a blunt, rude, impersonal, inefficient and often hated implement but it is surely advancing us towards that endpoint. now, if we could get the ehr systems to actually communicate with each other....

the perspective i see all too often is that if lots of other people that are not getting care now, suddenly start getting care, there will bew less care and more waiting and inconvenience for me. therefore, it's bad...except for the parts that benefit me. those are good. yup, perspective.

well, i'm shocked and i did read it. and much of it i agree with, especially the part about if it isn't my idea it won't work. that must be why it doesn't work!!! i can't think of a single medical IT product available that was primarily designed this way or works this way. if they were, we wouldn't see abbreviations for tests, diagnoses and treatments that are never used in medicine (just one example). we'd have systems that could parse information in notes routinely and collate them into the proper lists. and we wouldn't have so much keyboard data and note entry. almost every doc over 40 became a master of dictation in his training and career. that should be the primary data entry method. it's not. so yeah, some docs are luddites, many, if not most docs are arrogant but the IT people have generally dropped the ball repeatedly and there's more than enough justified criticism to go around.but to the original point, if the big players aren't here due to low profit margins and you are, how does that advance your thesis re generalists vs specialists in IT? microsoft and apple have a rep for paying well. they employ generalist IT people. presumably they're well paid. but if the profit margin in med IT is low isn't the pay disparity between a generalist working for a big player and a specialist working for a lower food chain org likely to be relatively low, at least in comparison to medicine?

interesting link, especially as berea is a model institution of learning imo: http://en.wikipedia.org/wiki/Berea_College. check out the diverse list of notable alums. nevertheless, there are many good paying jobs in the sciences. chemistry majors work in many industries, for example, at relatively high pay and opportunities for advancement. geologists possibly even more so especially in energy related industries. computer scientists, the same.

no, actually just those IT guys. EHR's in my view aren't primarily about improving patient care. they're primarily about oversight and billing. they're primarily about proving what providers including hospitals did or didn't do and whether they're entitled to reimbursement. they're also about measuring quality. unfortunately, i understand their necessity. but claiming that they've transformed patient care is a quantum leap. they may not have improved it at all.while were at it, where are the really big players in the EHR biz? where's apple for instance? microsoft? there's obviously plenty of money in it. why were we left with the winners among a group of losers in the run off to be the big providers of EHR's? maybe oc can help us here.